Friday, December 16, 2011

Placebos

The December 12 NEW YORKER contains an astonishing article by Michael Specter, "The Power of Nothing." It is an overview of clinical studies of the placebo effect, including an interview with the world's foremost researcher into placebos, Ted Kaptchuk of Harvard Medical School. The article, carefully non-biased, nonetheless shows determined believers in "alternative medicine" chipping away at the medical establishment. Kaptchuk's presence at Harvard, as a full professor, is proof of that. He holds neither a Ph.D. nor an M.D., yet has published in the most respected journals in the world.

The trouble with alternative medicine, in my view, is that it's such a hodge-podge. It includes out-and-out nuts, serious practitioners of herbology, religious faith healers, good doctors, and evil scams (remember laetrile? I had a friend who died of cancer, refusing conventional treatment and instead going to Mexico for dosing with apricot pits.) How do you separate the wheat from the chaff?

One way is by clinical trials. The article says that some of these have shown impressive results from placebos, especially in the areas of pain and chronic illness. Not so much with straightforward infection -- if you have bubonic plague, you need an antibiotic. But the whole basis of alternative medicine, that the mind can profoundly influence the body, has shown to be true in other types of disease.

These studies get very specific. Among the findings about placebos:

Conditioning techniques affect outcomes. People first given morphine and later a placebo have a different neurochemical response than those first given ibuprofen and later a placebo.

An injection of saline into a patient who has Parkinson's disease and has been told that the saline will help him, then produces more of the dopamine that his brain lacks.

As placebos, capsules produce a greater effect than tablets, and injections a greater effect still. Colored pills relieve pain better than white ones. Two pills produce more effect than one, even if both are no more than sugar.

Most astonishing of all: In some studies the placebo effect works even when the patients are TOLD it is a placebo, if the telling is done right. In the end, Ted Kaptchuk maintains, much comes down to the nature of the patient-doctor interaction. And this is where American medicine may often be lacking.